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Updated: Jul 2, 2026

A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation
Published on: January 17, 2011
Previous endotracheal aspirate allows guiding the initial treatment of ventilator-associated pneumonia
Boris Jung1, Mustapha Sebbane, Gerald Chanques
1Intensive Care Unit, Department of Critical Care and Anesthesiology, DAR B CHU de Montpellier, Hôpital Saint Eloi, 80 Avenue Augustin Fliche, 34295, Montpellier Cedex 5, France.
Objectives:
Any delay in adequate antibiotic treatment compromises the outcome of ventilator-associated pneumonia (VAP). However, the diagnosis and optimal treatment of VAP remain a challenge for intensivists. We assessed the potential impact of using results of routine weekly endotracheal aspirate (EA) cultures to guide initial antibiotic treatment for VAP.
Design And Setting:
Retrospective analysis of prospectively collected data in a medical-surgical intensive care unit (ICU) of a university hospital.
Patients And Methods:
We studied 113 VAP episodes and evaluated the concordance between the latest EA and the broncho-alveolar lavage (BAL). We stratified patients into three groups: concordant EA-BAL (concordant group), discordant EA-BAL (discordant group) and EA not performed group. We then compared the adequacy of the antibiotic prescribed initially and outcomes between the three groups.
Measurements And Main Results:
Ninety assessable EA-BAL samples were evaluated. When guided by EA, the initial antibiotic regimen was adequate in 85% of situations, a proportion significantly superior (P < 0.05) to that resulting from application of the ATS guidelines (73%). When clinicians did not have a pre-VAP EA to guide their treatment (EA not performed group), only 61% of treatments were adequate. No significant difference was observed between the three groups for length of mechanical ventilation, length of ICU stay, nonpulmonary nosocomial infections and mortality.
Conclusion:
Once-a-week routine quantitative EA cultures may help to improve the adequacy of empiric antibiotic therapy for VAP.
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